Purpose Homebound
5.15 Homebound Services I.
Description/Purpose Homebound services are part of the overall continuum of programs/services available in the District to meet the needs of students with disabilities under the Individuals with Disabilities Education Act (IDEA) or Section 504. Because students who are homebound do not have the opportunity to interact with peers, whether disabled or non-disabled, Homebound services are considered the most restrictive of instructional arrangements. Homebound services should be considered only for those students with medical or psychological conditions that preclude attendance in less restrictive campus-based instructional environments. All placements into the Homebound program must be time-limited with the IEP or Section 504 committee specifying conditions to be met for the student’s return to a less restrictive environment. For students on Homebound for medical or psychological reasons, those conditions must include a release from the medical doctor or psychologist approving the return to the home campus.
II.
Service Delivery Models Homebound services are generally provided for four (4) or five (5) hours per week in no more than three (3) content areas. Students are expected to need the service for a minimum of four (4) consecutive weeks. For students needing services for less than four weeks, home-based services may be more appropriate. (In a home-based service model, the parent is responsible for collecting assignments from the home campus and returning completed assignment to the home campus on a weekly basis.) However, the IEP/Section 504 committee has the ultimate responsibility for determining the type and amount of services that will meet each individual student’s educational needs. Homebound services are provided by either a full-time Homebound teacher during the regular school day or, when a full-time Homebound teacher is not available, a district teacher after the regular school day (e.g., 4:00 – 6:30 p.m., twice a week).
III.
Home Campus Responsibilities Upon receiving a request for Homebound services, the campus administrator shall provide the parent with a copy of the Authorization for Homebound Instruction form. This form must be signed by a licensed healthcare provider (e.g., medical doctor, physician’s assistant, nurse practitioner, psychologist, or licensed master social worker). Prior to an IEP/Section 504 meeting, wherein the IEP/Section 504 committee plans to consider Homebound services for a particular student, an administrator from the student’s
1
home campus must inform the Director of Special Education via e-mail that the committee is considering Homebound services. In order to avoid a lapse in services when Homebound is being considered, it is highly recommended that campus administration recruit a teacher to provide Homebound services prior to the IEP/Section meeting. The student’s caseload teacher, who may or may not be assigned as the Homebound teacher, will nevertheless continue to be the teacher responsible for scheduling IEP/Section 504 meetings, collecting student data, writing the IEP/Section 504 Accommodation Plan and remaining in contact with the Homebound teacher and parent/guardian, etc. The following district teachers may be contracted to provide Homebound services. The list below is in descending order of preference. The first two are always preferable when available.
Current Special Education Teacher of the Child Current Regular Education Teacher of the Child Special or Regular Education Teacher at Home School of Child District Special Education Teacher District General Education Teacher District Homebound Teacher (Priority: Medically-Fragile students who cannot, under any circumstances, participate in school-based instruction.)
The Homebound Teacher Assignment and Student Release Form must be completed and signed by the campus administrator from the student’s home campus immediately following the IEP/Section 504 meeting wherein Homebound services are recommended. It is the responsibility of the student’s home campus to provide the assigned Homebound teacher with all information, supplies, and/or materials needed to implement the Homebound instruction/services identified in the IEP. The home campus Data Entry Clerk shall withdraw the student from the home campus and note the transfer of the student into Campus 300. The home campus Data Entry Clerk must also immediately notify the Special Education Secretary via e-mail that the student has been withdrawn and transferred to Campus 300. The Special Education Secretary will inform Special Education Data Entry Clerk to officially enroll the student into Campus 300. When a Homebound Teacher is Available at the Home Campus When there is a Homebound teacher available at the student’s home campus, the assigned teacher will be given the completed Homebound Teacher Assignment and Student Release Form immediately after the IEP/Section 504 meeting. The Homebound Teacher
2
Assignment and Student Release Form shall be taken by the assigned Homebound teacher to the Special Education Budget Specialist at the Special Education Complex where an Employee Contracted Services Agreement (ECSA) will be issued to the Homebound teacher. When a Homebound Teacher is Not Available at the Home Campus When there is no Homebound teacher available at the student’s home campus, the campus administrator shall send a request for a Homebound teacher via e-mail to the Special Education Department Secretary. The Special Education Department Secretary will assist the campus in finding a Homebound teacher from another campus in the district. Once a potential Homebound teacher is found, he or she will be asked to report to the administrator at the student’s home campus and be provided the Homebound Teacher Assignment and Student Release Form. The Homebound Teacher Assignment and Student Release Form shall be taken by the assigned Homebound teacher to the Special Education Budget Specialist at the Special Education Complex where an Employee Contracted Services Agreement (ECSA) will be issued to the Homebound teacher.
IV.
Homebound Teacher Responsibilities The following is a list of Homebound teacher responsibilities:
Prior to initiating Homebound services, obtain an Employee Contracted Services Agreement (ECSA) from the Special Education Department.
Make initial contact with the parent to arrange a mutually agreeable schedule for the delivery of Homebound services.
Prior to initiating Homebound services, contact the home campus staff so that the class/course content taught during Homebound is aligned to the class/course content taught at school as much as possible.
Obtain all books and materials required for Homebound instruction from the student’s home campus.
Once Homebound services have been initiated, document each instructional session using the Homebound Instruction Log. The parent is required to sign the Homebound Instruction Log immediately after each session.
Submit the student’s grades earned at the end of each nine-week grading period, and upon a student’s dismissal from Homebound, to the Special Education Department by completing the Record of Homebound Student Grades.
3
V.
After the student is dismissed from Homebound, immediately provide a copy of the Record of Homebound Student Grades to the home campus administrator.
Return all books and materials to the home campus immediately upon the student’s dismissal from Homebound.
Requirements for Homebound Teacher to Receive Payment for Services The Special Education Budget Specialist will inform the Homebound teacher of payroll deadlines. The Homebound teacher must submit the completed Homebound Instruction Log (with parent signatures), lesson plans, student work samples and the Mileage Reimbursement Request form to the Special Education Budget Specialist within thirtycalendar days of providing Homebound services.
VI.
Responsibilities of Parent/Student
It is the responsibility of the parent/guardian to provide a safe and clean environment conducive to learning.
A responsible adult must be present in the home at all times during the Homebound instructional period.
When the student is an adult student (i.e, age 18 or over), a responsible nonstudent adult family member must be present in the home at all times during the Homebound instructional period.
The parent/guardian must notify the Homebound teacher, prior to the instructional day and time, anytime the student will not be present and/or ready for instruction.
Upon observing a continuing pattern of absences or other behaviors detrimental to learning, the Homebound teacher will notify the administrator at the home campus to schedule a meeting to review the continued provision of Homebound services. *****
4
Gadsden Independent School District P.O. Drawer 70 Anthony, NM 88021 Special Education Office: 575-882-6221
AUTHORIZATION FOR HOMEBOUND INSTRUCTION
INSTRUCTIONS FOR HEALTHCARE PROVIDER: Please complete this form and return directly to:
SCHOOL NAME: _____________________________________ Address or Fax:______________________________________ ___________________________________________________ ___________________________________________________
ATTENTION: _______________________________________ Position: _______________________________________ Telephone: _______________________________________
GENERAL INFORMATION Student Name
Gender
Last, First, Middle Initial
□ Male □ Female
Birthdate Month/Day/Year
Parent(s)/Guardian(s) Name Address
Street, City, County, State, ZIP
LISCENSED PROFESSIONAL’S STATEMENT Diagnosis: Description of Physical or Emotional Condition:
Why is this student unable to attend his/her home school for instruction?
Anticipated length of time student will not be able to attend his/her home school:
Please list any medical restrictions/conditions which may interfere with the provision of Homebound Instruction:
Homebound Instruction is designed to be a temporary educational placement. Under what conditions could this student possibly return to his/her home school?
Licensed Professional’s Name
Address
THANK YOU VERY MUCH FOR YOUR ASSISTANCE! Print or Type Clinic Name/Office
Street, City, State, ZIP
Authorized Signature and Credentials
Telephone
Date Signed
SY 2017-2018
GADSDEN INDEPENDENT SCHOOL DISTRICT
Special Education Department
Homebound Teacher Assignment and Student Release Form Directions: This form must be submitted with the IEP/Section 504 paperwork to the Special Education Department prior to initiating Homebound services. Student: Parent Name: Home Address: Homebound Teacher:
DOB: Telephone:
Campus:
Check One: Special Education
Grade: Section 504
Reason for Homebound Services: Medical (explain): _______________________________________________________________________ Psychological (explain): __________________________________________________________________ Other (explain): _________________________________________________________________________ Anticipated Duration of Homebound Services: Beginning Date: ___________________________ Estimated Ending Date: ___________________________ Description of Classes/Courses/Services to be provided on Homebound Course Code Course Name
Description of Related Services (including service time) to be provided on Homebound (if any)
Other Factors Relevant to Homebound Services (if any) __________________________________________________________________________________________ __________________________________________________________________________________________
_________________________________________ __________________________ Signature Campus Administrator Date --------------------------------------------------------------------------------------------------------------------------------------For Special Education Office Use Only Teacher Assigned to Provide Homebound Services: Date SPED Dept. Notified of Homebound Assignment: Special Education Secretary Signature and Date SY 2017-2018
GADSDEN INDEPENDENT SCHOOL DISTRICT
Special Education Department
Homebound Instruction Log Directions: This form must be submitted to the Special Education Department along with copies of lesson plans and student work samples prior to end of each pay period. Student: Parent Name: Home Address: Homebound Teacher: Date
Start Time
DOB: Telephone:
Campus:
Check One: Special Education
End Time
Total Time
Grade: Section 504
Subject Area Covered *Parent Signature
Total Instruction Time + Total Preparation Time (Instruction Time x 20%) = Total Hours Submitted for Reimbursement
*Parent signature is required after EACH Homebound Instructional Session.
_______________________________________________ ___________________ Homebound Teacher Signature Date ------------------------------------------------------------------------------------------------------------------------------For Special Education Office Use Only Total Hours Approved for Payment: Funding Account Code:
Amount:
$
APPROVED BY: Director of Special Education
Date
SY 2017-2018
GADSDEN INDEPENDENT SCHOOL DISTRICT
Special Education Department
Record of Homebound Student Grades Directions: This form MUST be completed and submitted to the Special Education Department every nineweeks AND *after student is dismissed from the Homebound program. Student: Parent Name: Home Address: Homebound Teacher:
Class Code
DOB: Telephone:
Campus:
Check One: Special Education
Course Name
Grade Earned
Grade: Section 504
Credit Earned (High School Only) YES NO YES NO
_______________________________________________________ Signature of Homebound Teacher Verifying Attendance and Grades
___________________ Date
_______________________________________________________ Special Education Director
___________________ Date
*After the student is released from Homebound, a copy of this form shall be sent to the home campus administrator.
SY 2017-2018
Description/Purpose Homebound services are part of the overall continuum of programs/services available in the District to meet the needs of students with disabilities under the Individuals with Disabilities Education Act (IDEA) or Section 504. Because students who are homebound do not have the opportunity to interact with peers, whether disabled or non-disabled, Homebound services are considered the most restrictive of instructional arrangements. Homebound services should be considered only for those students with medical or psychological conditions that preclude attendance in less restrictive campus-based instructional environments. All placements into the Homebound program must be time-limited with the IEP or Section 504 committee specifying conditions to be met for the student’s return to a less restrictive environment. For students on Homebound for medical or psychological reasons, those conditions must include a release from the medical doctor or psychologist approving the return to the home campus.
II.
Service Delivery Models Homebound services are generally provided for four (4) or five (5) hours per week in no more than three (3) content areas. Students are expected to need the service for a minimum of four (4) consecutive weeks. For students needing services for less than four weeks, home-based services may be more appropriate. (In a home-based service model, the parent is responsible for collecting assignments from the home campus and returning completed assignment to the home campus on a weekly basis.) However, the IEP/Section 504 committee has the ultimate responsibility for determining the type and amount of services that will meet each individual student’s educational needs. Homebound services are provided by either a full-time Homebound teacher during the regular school day or, when a full-time Homebound teacher is not available, a district teacher after the regular school day (e.g., 4:00 – 6:30 p.m., twice a week).
III.
Home Campus Responsibilities Upon receiving a request for Homebound services, the campus administrator shall provide the parent with a copy of the Authorization for Homebound Instruction form. This form must be signed by a licensed healthcare provider (e.g., medical doctor, physician’s assistant, nurse practitioner, psychologist, or licensed master social worker). Prior to an IEP/Section 504 meeting, wherein the IEP/Section 504 committee plans to consider Homebound services for a particular student, an administrator from the student’s
1
home campus must inform the Director of Special Education via e-mail that the committee is considering Homebound services. In order to avoid a lapse in services when Homebound is being considered, it is highly recommended that campus administration recruit a teacher to provide Homebound services prior to the IEP/Section meeting. The student’s caseload teacher, who may or may not be assigned as the Homebound teacher, will nevertheless continue to be the teacher responsible for scheduling IEP/Section 504 meetings, collecting student data, writing the IEP/Section 504 Accommodation Plan and remaining in contact with the Homebound teacher and parent/guardian, etc. The following district teachers may be contracted to provide Homebound services. The list below is in descending order of preference. The first two are always preferable when available.
Current Special Education Teacher of the Child Current Regular Education Teacher of the Child Special or Regular Education Teacher at Home School of Child District Special Education Teacher District General Education Teacher District Homebound Teacher (Priority: Medically-Fragile students who cannot, under any circumstances, participate in school-based instruction.)
The Homebound Teacher Assignment and Student Release Form must be completed and signed by the campus administrator from the student’s home campus immediately following the IEP/Section 504 meeting wherein Homebound services are recommended. It is the responsibility of the student’s home campus to provide the assigned Homebound teacher with all information, supplies, and/or materials needed to implement the Homebound instruction/services identified in the IEP. The home campus Data Entry Clerk shall withdraw the student from the home campus and note the transfer of the student into Campus 300. The home campus Data Entry Clerk must also immediately notify the Special Education Secretary via e-mail that the student has been withdrawn and transferred to Campus 300. The Special Education Secretary will inform Special Education Data Entry Clerk to officially enroll the student into Campus 300. When a Homebound Teacher is Available at the Home Campus When there is a Homebound teacher available at the student’s home campus, the assigned teacher will be given the completed Homebound Teacher Assignment and Student Release Form immediately after the IEP/Section 504 meeting. The Homebound Teacher
2
Assignment and Student Release Form shall be taken by the assigned Homebound teacher to the Special Education Budget Specialist at the Special Education Complex where an Employee Contracted Services Agreement (ECSA) will be issued to the Homebound teacher. When a Homebound Teacher is Not Available at the Home Campus When there is no Homebound teacher available at the student’s home campus, the campus administrator shall send a request for a Homebound teacher via e-mail to the Special Education Department Secretary. The Special Education Department Secretary will assist the campus in finding a Homebound teacher from another campus in the district. Once a potential Homebound teacher is found, he or she will be asked to report to the administrator at the student’s home campus and be provided the Homebound Teacher Assignment and Student Release Form. The Homebound Teacher Assignment and Student Release Form shall be taken by the assigned Homebound teacher to the Special Education Budget Specialist at the Special Education Complex where an Employee Contracted Services Agreement (ECSA) will be issued to the Homebound teacher.
IV.
Homebound Teacher Responsibilities The following is a list of Homebound teacher responsibilities:
Prior to initiating Homebound services, obtain an Employee Contracted Services Agreement (ECSA) from the Special Education Department.
Make initial contact with the parent to arrange a mutually agreeable schedule for the delivery of Homebound services.
Prior to initiating Homebound services, contact the home campus staff so that the class/course content taught during Homebound is aligned to the class/course content taught at school as much as possible.
Obtain all books and materials required for Homebound instruction from the student’s home campus.
Once Homebound services have been initiated, document each instructional session using the Homebound Instruction Log. The parent is required to sign the Homebound Instruction Log immediately after each session.
Submit the student’s grades earned at the end of each nine-week grading period, and upon a student’s dismissal from Homebound, to the Special Education Department by completing the Record of Homebound Student Grades.
3
V.
After the student is dismissed from Homebound, immediately provide a copy of the Record of Homebound Student Grades to the home campus administrator.
Return all books and materials to the home campus immediately upon the student’s dismissal from Homebound.
Requirements for Homebound Teacher to Receive Payment for Services The Special Education Budget Specialist will inform the Homebound teacher of payroll deadlines. The Homebound teacher must submit the completed Homebound Instruction Log (with parent signatures), lesson plans, student work samples and the Mileage Reimbursement Request form to the Special Education Budget Specialist within thirtycalendar days of providing Homebound services.
VI.
Responsibilities of Parent/Student
It is the responsibility of the parent/guardian to provide a safe and clean environment conducive to learning.
A responsible adult must be present in the home at all times during the Homebound instructional period.
When the student is an adult student (i.e, age 18 or over), a responsible nonstudent adult family member must be present in the home at all times during the Homebound instructional period.
The parent/guardian must notify the Homebound teacher, prior to the instructional day and time, anytime the student will not be present and/or ready for instruction.
Upon observing a continuing pattern of absences or other behaviors detrimental to learning, the Homebound teacher will notify the administrator at the home campus to schedule a meeting to review the continued provision of Homebound services. *****
4
Gadsden Independent School District P.O. Drawer 70 Anthony, NM 88021 Special Education Office: 575-882-6221
AUTHORIZATION FOR HOMEBOUND INSTRUCTION
INSTRUCTIONS FOR HEALTHCARE PROVIDER: Please complete this form and return directly to:
SCHOOL NAME: _____________________________________ Address or Fax:______________________________________ ___________________________________________________ ___________________________________________________
ATTENTION: _______________________________________ Position: _______________________________________ Telephone: _______________________________________
GENERAL INFORMATION Student Name
Gender
Last, First, Middle Initial
□ Male □ Female
Birthdate Month/Day/Year
Parent(s)/Guardian(s) Name Address
Street, City, County, State, ZIP
LISCENSED PROFESSIONAL’S STATEMENT Diagnosis: Description of Physical or Emotional Condition:
Why is this student unable to attend his/her home school for instruction?
Anticipated length of time student will not be able to attend his/her home school:
Please list any medical restrictions/conditions which may interfere with the provision of Homebound Instruction:
Homebound Instruction is designed to be a temporary educational placement. Under what conditions could this student possibly return to his/her home school?
Licensed Professional’s Name
Address
THANK YOU VERY MUCH FOR YOUR ASSISTANCE! Print or Type Clinic Name/Office
Street, City, State, ZIP
Authorized Signature and Credentials
Telephone
Date Signed
SY 2017-2018
GADSDEN INDEPENDENT SCHOOL DISTRICT
Special Education Department
Homebound Teacher Assignment and Student Release Form Directions: This form must be submitted with the IEP/Section 504 paperwork to the Special Education Department prior to initiating Homebound services. Student: Parent Name: Home Address: Homebound Teacher:
DOB: Telephone:
Campus:
Check One: Special Education
Grade: Section 504
Reason for Homebound Services: Medical (explain): _______________________________________________________________________ Psychological (explain): __________________________________________________________________ Other (explain): _________________________________________________________________________ Anticipated Duration of Homebound Services: Beginning Date: ___________________________ Estimated Ending Date: ___________________________ Description of Classes/Courses/Services to be provided on Homebound Course Code Course Name
Description of Related Services (including service time) to be provided on Homebound (if any)
Other Factors Relevant to Homebound Services (if any) __________________________________________________________________________________________ __________________________________________________________________________________________
_________________________________________ __________________________ Signature Campus Administrator Date --------------------------------------------------------------------------------------------------------------------------------------For Special Education Office Use Only Teacher Assigned to Provide Homebound Services: Date SPED Dept. Notified of Homebound Assignment: Special Education Secretary Signature and Date SY 2017-2018
GADSDEN INDEPENDENT SCHOOL DISTRICT
Special Education Department
Homebound Instruction Log Directions: This form must be submitted to the Special Education Department along with copies of lesson plans and student work samples prior to end of each pay period. Student: Parent Name: Home Address: Homebound Teacher: Date
Start Time
DOB: Telephone:
Campus:
Check One: Special Education
End Time
Total Time
Grade: Section 504
Subject Area Covered *Parent Signature
Total Instruction Time + Total Preparation Time (Instruction Time x 20%) = Total Hours Submitted for Reimbursement
*Parent signature is required after EACH Homebound Instructional Session.
_______________________________________________ ___________________ Homebound Teacher Signature Date ------------------------------------------------------------------------------------------------------------------------------For Special Education Office Use Only Total Hours Approved for Payment: Funding Account Code:
Amount:
$
APPROVED BY: Director of Special Education
Date
SY 2017-2018
GADSDEN INDEPENDENT SCHOOL DISTRICT
Special Education Department
Record of Homebound Student Grades Directions: This form MUST be completed and submitted to the Special Education Department every nineweeks AND *after student is dismissed from the Homebound program. Student: Parent Name: Home Address: Homebound Teacher:
Class Code
DOB: Telephone:
Campus:
Check One: Special Education
Course Name
Grade Earned
Grade: Section 504
Credit Earned (High School Only) YES NO YES NO
_______________________________________________________ Signature of Homebound Teacher Verifying Attendance and Grades
___________________ Date
_______________________________________________________ Special Education Director
___________________ Date
*After the student is released from Homebound, a copy of this form shall be sent to the home campus administrator.
SY 2017-2018
